Digital healthcare is the way forward

The focus of modern healthcare is around lifestyle issues such as obesity and diabetes. Picture: PA

• by GRANT CUMMING

Published on the 16 April 2014

Patients can be taught self-care, says Grant Cumming

A new building named the Alexander Graham Bell Centre, located on the campus of Moray College UHI in Elgin, will be officially opened in June to further the pioneering work already being done in the area on digital healthcare or e-health. Detailed attention has been paid to the internal architecture because the centre’s purpose is to bring together – and create a flow of ideas between – people working in digital healthcare in the public and private sectors as well as medics, social workers and academics.

Drawing on the “social physics” ideas of Massachusetts Institute of Technology, professor Alex Pentland, among others, the centre will be a hub for developing new and innovative ways of providing healthcare using information and communication technology (ICT).

Social physics outlines how human behaviour is driven by the exchange of ideas and learning from each other. It also identifies how large amounts of very specific data available on the internet through different types of computer technology can be used to help this process.

For example, one in four people in Moray consults the internet prior to visiting their GP, giving doctors an insight into the value of highlighting credible sources of information to patients which might allow them to look after themselves.

We can no longer afford to deliver healthcare under the existing model. Our system was built to deal with infection and while we will always have infection, the focus of modern healthcare is around lifestyle issues such as obesity and diabetes.

The traditional model is reactive when we need to be concentrating much more on preventative and personalised medicine – we need new ideas on how we engage with a person and their wellbeing throughout their life and that is what the centre is there to generate.

In part, the challenge is subtly to alter the behaviour of patients. As well as Alex Pentland’s, the work of behavioural economists Richard Thaler and Cass Sunstein on nudging people to take action and that of psychologist Daniel Kahneman, whose global bestseller Thinking Fast and Slow contrasts fast, instinctive and emotional thinking with slower, more logical thinking in human decision-making, has been influential.

We can teach people to look after themselves. We need an element of nudging – persuading people to take action, for example by highlighting the dangers of smoking. We also need budging – making people take action, for example the ban on smoking in public spaces. We can use information and new technology, perhaps even gaming, to create, for instance, a fun way to exercise to get a message over to some groups.

The internet is now a social web where we can order goods and interact with people, where information within documents can be linked and disparate databases mined for more information.

We must look at how we can connect and collaborate and use that technology to improve the delivery of healthcare, and where better to develop that format than here in Moray?

Moray has already won global recognition for its excellence in the field of digital health, hosting a World Health Organisation conference on the subject in 2012. And two of the four projects in the UK to have received substantial funding under the DALLAS (Delivering Assisted Living Lifestyle at Scale) scheme are in Moray.

They are:

n Year Zero, an online application which enables people to manage their health information and includes an online family tree, a digital version of the red book that is given to all parents to record their child’s health and Rally Round, a social networking and planning tool to connect family, friends, carers and health and care professionals.

n Living It Up, which uses connected TVs to give people access to health and community information within their own homes. Moray is the test bed area for the project.

It is hoped that the Alexander Graham Bell Centre will further enhance the area’s reputation for digital healthcare.The centre has conference facilities, eight classrooms, custom-built corridor learning pods for students, a community hub and café. It also has a mock hospital ward, a resuscitation training room, research facilities and space for new enterprises.

The whole place will be a melting pot for ideas, a safe space in which we hope we will be able to redesign how we deliver healthcare.

• The £6.5 million Alexander Graham Bell Centre has been funded by Highlands and Islands Enterprise, Moray College UHI, NHS Grampian and the European Regional Development Fund. 

Professor Grant Cumming, Consultant Obstetrician and Gynaecologist, Dr Gray’s Hospital, Elgin is one of the medical professionals behind the creation of the centre.

http://www.scotsman.com/news/digital-healthcare-is-the-way-forward-1-3377637

Welcome to Zappos-Style Health Innovation

Rushika Fernandopulle1/14/14

But there’s another unusual aspect to this clinic. Many of the patients will be paying for care out of their own pockets, thereby sidestepping the administrative overhead and pressures caused by health insurance.Zappos CEO Tony Hsieh’s effort to revitalize downtown Las Vegas includes last month’s launch of a new clinic, run by Iora Health and spearheaded by physician Zubin Damania. Stanford-trained, Damania also happens to rap by the name of ZDoggMD. So it’s no wonder the project has drawn attention.

A growing number of primary care doctors see this not only as a respite from their increasingly demoralizing work circumstances, but as a chance to do what they dreamed of in medical school. Research has long shown that good primary care is the cornerstone of a cost-effective healthcare system. In this type of setting, they can do more to help their patients—and without working to exhaustion or running up huge costs.

The patients pay for their care out of their own pockets with a modest ($60-80) monthly subscription fee. Annualized, that’s actually lower than many of today’s health plan deductibles. The doctors spend as much time with the patients as needed. They are even accessible 24/7 by phone and e-mail. In addition, each patient gets a personal health coach to help them improve their health. A coach may help diabetics learn to shop for food or help people with respiratory problems learn to allergy-proof their home.

Getting rid of insurance overhead alone cuts costs by as much as 40 percent. Letting the doctors take their time and concentrate on treatment and diagnosis also saves big money in the long run. Iora practices, and others like them, have reported savings in the 20 to 30 percent range so far.

One reason for that: The more time that primary care doctors spend with their patients, the fewer referrals to costly specialists they make, and fewer tests and procedures they need to order. Over the last ten years, the rate of referrals has skyrocketed as primary care doctors have been squeezed to do more in less time. In the 10-to-15-minute window insurance reimburses for, there is often little time to do more than type in a referral.

These newer types of clinics are a growing phenomenon in U.S. healthcare. They are referred to as concierge or direct primary care. The concierge practices are usually high-priced, cater to wealthy patients, and provide extra frills. But price-friendly, subscription-based primary care is now catching on. The number of such offices is growing at a rate of 25 percent per year, according to the American Academy of Private Physicians.

Some big-name investors seem to agree there’s promise in this approach. Hsieh recently invested in our company, Iora Health. Amazon’s Jeff Bezos was an early investor in one of our competitors, Qliance, as were Michael Dell and Drew Carey. We and others have attracted a growing number of venture capital investments as well.

Direct primary care is not just for the rich or middle class. In New York, we are partnering with Grameen PrimaCare to provide health care for members of Grameen America, a microfinance organization founded by Nobel Peace Laureate Muhammad Yunus. Together, we are building a clinic to open in mid-2014 that can meet the needs of even the poorest of New York’s working poor.

What’s driving this trend? Recent reports about insurance rate shock and big out-of-pocket expenses remind us that simply giving people access to health insurance doesn’t make them healthier. If they can’t afford the premiums or deductibles, they won’t get care. Company CEOs are particularly familiar with this problem. They want their employees to be healthy without breaking the bank. In a recent Gallup survey, 30 percent of adults reported skipping needed care because of costs.

Imagine spending as long as you need talking to your doctor about your health. What if your mother’s doctor called the hospital before she was admitted, stayed in close communication with them during her stay, and then saw her the day she was released to review her medications and treatment plan?

A provision in Obamacare even allows insurance companies to offer very low cost policies (wrap arounds) that complement this new enhanced primary care service. These policies only cover the type of specialized care you can’t get in your family doctor’s office as well as tests, hospital care, and medications, making them especially affordable. Will insurance companies see an advantage to offering such plans? Uptake nationally so far has been slow, but we are working with the Nevada Health Co-Op to offer just such a plan for the Las Vegas practice.

The self-pay primary care movement is currently small; only about half a million patients use such a practice today. But the patients who do use it report tremendous satisfaction. Direct primary care could be a big boon for middle-class patients caught between rising costs and shrinking paychecks.

For the working poor, however, such a model could be lifesaving. That’s why we plan eventually to build such clinics throughout the world. Imagine the U.S. exporting affordable care delivery to the rest of the globe? That would certainly get people’s attention.

Rushika Fernandopulle is a primary care physician, former director of the Harvard Interfaculty Program for Health Systems Improvement, and the co-founder and CEO of Iora Health. Follow @rushika1

http://www.xconomy.com/boston/2014/01/14/welcome-to-zappos-style-health-innovation/

Do you want to practice medicine without the hassle and expense of dealing with the insurance companies?

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The platform will go live on August 1, 2013 and we are now ready to begin signing up providers.

If you are currently practicing in the telehealth space or providing “concierge” care, this site is for you!

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www.mymd365.com

Digital and mobile startups are fueling health care innovation in Dallas

Home > Business > Health Care 

  /Vivify Health

“Driven by extreme demands on the crumbling U.S. health care system, care must now be delivered outside the four walls of the hospital,” says Vivify CEO Eric Rock.

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By HANAH CHO

Staff Writer

hcho@dallasnews.com

Published: 15 June 2013 04:44 PM

Updated: 16 June 2013 05:12 PM

Entrepreneurs across the country are transforming the health care industry through technology.

Digital and health information tech startups are growing as doctors, hospitals and administrators look for ways to provide better care and reduce costs under federal mandates.

Consumers, too, are embracing mobile tools to be healthy.

Dallas is no exception.

“D-FW has a tremendous amount of health information technology activity, far more than we give ourselves credit for,” said Dr. Hubert Zajicek, co-founder of Health Wildcatters, a new seed accelerator for digital health startups in Dallas.

“An extremely competitive health care delivery market in the most rapidly growing top five American metro areas, combined with our strengths in technology and telecom, provides fertile grounds to grow and support the newest crop of innovative health care startups in Dallas,” he said.

To get a picture of the activity, we talked with executives from three health care startups in D-FW:

Vivify Health, a Plano company that developed a cloud-based platform for remote patient monitoring.

Axxess Technology Solutions, a Dallas company that uses cloud-based software to perform administrative functions for home health care agencies.

DealWell, a Dallas firm that has a website where people can shop for the best deals in health care services.

Vivify Health

For the last several years, Vivify has been developing its platform for remote patient monitoring and testing it with several hospitals and other partners, such as Texas Health Resources and AT&T Inc.

In May, the company announced it raised funds from venture firms Ascension Health Ventures and Heritage Group, whose partners include hundreds of hospitals. The startup, founded as Intuitive Health in 2009, also rebranded itself.

Regulatory filings put the investment at $3.4 million, but founder and CEO Eric Rock said the amount is much larger, though he declined to provide an exact number.

With the funds, Vivify plans to jump-start the marketing of its platform to users, such as hospitals, home health care agencies and physician practices. It also plans to offer a direct-to-consumer product soon.

Rock described Vivify’s software as a tool that seeks to reduce hospital readmissions, improve care and reduce costs — challenges facing the health care industry amid reforms.

“Driven by extreme demands on the crumbling U.S. health care system, care must now be delivered outside the four walls of the hospital,” Rock said.

Vivify’s software, Rock said, is less costly and easier to use for both patients and providers because it uses common consumer devices, such as mobile tablets and computers. The platform also provides video conferencing, educational health videos and customized care plans.

Here’s how it works: Using a tablet, for instance, patients log onto the Vivify platform from their home. Depending on the plan customized by a physician or provider, patients typically answer a daily health survey, keeping track of their weight, blood pressure and other vital signs. Vivify’s platform can be integrated with other devices like a scale or a blood glucose meter.

On the other end, doctors can monitor the patient’s progress remotely.

Preliminary results from a pilot involving AT&T and Texas Health Resources using Vivify’s platform have shown positive patient feedback and reduced readmissions for chronic heart patients, according to the Texas Health Research & Education Institute.

St. Vincent Health, Indiana’s largest health system, is getting ready to launch a large-scale program to monitor patients using Vivify’s software in July, said Dr. Alan D. Snell, St. Vincent’s chief medical informatics officer.

On any given day, health care providers expect to monitor 500 patients who have complex chronic diseases, as well as those discharged with specific diagnoses such as heart failure, heart attack and pneumonia, Snell said.

St. Vincent chose Vivify as its software vendor because of “the flexibility of their platform and software, their analytic capabilities and their progressive view of where remote care management should be going,” Snell said.

Vivify is Rock’s third startup and second in health care.

Two previous ventures had successful exits. His first, ProHost, a table management system for restaurants, was sold to OpenTable. MedHost, focused on emergency room information systems, was also acquired.

Axxess

In six years, Axxess Technology Solutions has grown into an $8 million business.

Dallas-based Axxess provides cloud-based software that serves as the clinical, operational and administrative backbone for home health care agencies.

The home care market represents about $68 billion a year in U.S. health spending, according to McKinsey & Co. The consulting firm said in a study that technology can be the main driver for expanding the market.

Axxess CEO Niyi “John” Olajide saw the underserved technology market in the sector when he started his business as a one-person consultant a decade ago.

At that time, he was a telecommunications engineering student at University of Texas at Dallas. While visiting an aunt who was an administrator at a home care agency, Olajide noticed the computers were not set up under one network.

After inquiring about the issue, he was hired as an IT consultant. That job led to others, and Axxess was officially created in 2007.

After realizing that Olajide was solving similar problems for his clients, Axxess decided to develop Web-based software that would help home care agencies automate their business. The product launched in 2011.

“We saw a need for that and set out for the home health care software market and haven’t looked back since,” Olajide said.

Administrators and health care providers can schedule patient visits, bill insurance providers and document patient care plans using Axxess’ software. Since it is cloud-based, nurses can update patient files or access medication guides on any mobile device during a home visit.

For MedPro Health Providers, a home care agency outside of Chicago, using Axxess’ software has reduced time on paperwork, cut the hassle of billing and made patient care coordination among the various providers easier, said chief executive Riz Villasenor.

“As we work with hospitals and other institutions, the ability to share information swiftly and the right information is also a big plus when you’re working in an environment like health care,” Villasenor said.

Today the startup has 800 customers in almost 40 states, serving about 150,000 patients.

Olajide bootstrapped the business and has not taken any outside investment. The startup has been profitable since 2011.

Now the firm, which has 53 employees, faces a different challenge.

“We’re always looking for talented people, and we can’t find them fast enough to maintain our pace of growth and innovation,” he said.

DealWell

The Internet has changed the way we shop for most everything.

One exception has been health care. Now, an increasing number of startups are trying to create marketplaces where consumers can shop around for the best deals for medical services.

Dallas-based DealWell is one such company.

The website officially launched in August to offer services in nine categories in the Dallas-Fort Worth region. They are chiropractic services, cosmetic surgery, dental, eye exams/Lasik, hormone therapy, massage, medical imaging, medical/day spa, and weight loss and management.

“We’re bringing price transparency and comparison shopping,” said Geoffrey Fischer, DealWell’s chief executive, whose experience includes working at Microsoft’s MSN division. “We’re making the market more efficient and helping customers get good deals.”

The startup is backed by Plano-based Preferred Medical Holdings, a provider of MRI services in the region.

Every offer on the site is at least 20 percent off retail and as much as 85 percent in some cases. DealWell vets providers that sign up, checking their credentials.

Consumers can buy a deal or bid for a better one. Think of DealWell as being like Priceline for health and wellness services.

And unlike popular deal sites, offers do not expire and consumers can choose from a variety of providers for a single service, Fischer said.

Fischer declined to provide revenue but noted that sales have been increasing 25 percent monthly. Several thousand customers have bought a deal on the site.

DealWell takes a cut of each sale. Fischer declined to give an exact figure but noted that it was far less than the 50 percent split that deal sites like Groupon reportedly take.

DealWell providers also pay a small monthly fee to participate.

William A. Moore, clinical director of Dallas-based Advanced Skin Fitness and Advanced Men’s Clinic, has been using DealWell since last fall.

Moore said the clinics have seen a “great return” from DealWell. In several cases, DealWell customers have bought additional services.

“They’re not deal hopping,” he said. “They seem to be a more loyal clientele.”

Follow Hanah Cho on Twitter at @hanahcho.

By the numbers: Digital health care

73: Percent of doctors who believe health information technology will improve the quality of health care in the long term

43: Percent of physicians who use mobile health technology for clinical purposes

35: Percent of U.S. hospitals that have converted to electronic health records

44 million: Number of mobile health care and health apps downloaded in 2012

$1.4 billion: Amount of venture funding raised for digital health startups in 2012

SOURCES: Deloitte; U.S. Department of Health and Human Services; Juniper; Rock Health

http://www.dallasnews.com/business/health-care/20130615-digital-and-mobile-startups-are-fueling-health-care-innovation-in-dallas.ece

Cerner Achievement and Innovation Awards 2013 recognize excellence in adopting health care IT technology in the Middle East

Cerner, a developer of information management systems geared towards health care, recently announced the winners of the Cerner Achievement & Innovation Awards 2013, during a gala awards ceremony at The Address Hotel Marina in Dubai.

Attended by more than 150 of the region's leading health care professionals, the Cerner Achievement & Innovation Awards honored clients that have effectively delivered quality solutions across four different categories.

Abu Dhabi Health Services Company PJSC (SEHA) led the 2013 awardees after it was selected for Achievement & Innovation in Patient Care Delivery, Achievement & Innovation in Patient Care Delivery in Departmental Experience, and Achievement & Innovation in Physician Experience.

SEHA received the Patient Care Delivery award after successfully developing a fully mobile clinic to go to schools, rural areas, national screening and major events in Abu Dhabi.

SEHA was recognized in the Patient Care Delivery in Departmental Experience category after it successfully linked the Cerner Millennium electronic health record to the Health Authority of Abu Dhabi (HAAD) to automate the process of reporting all injuries and poisonings through a stand-alone database.

SEHA received the Physician Experience award when it leveraged the core Cerner Millennium toolset to create a custom reporting system targeted at the Dental services area, allowing the service line to be fully integrated into the main electronic health record.

King Faisal Specialist Hospital & Research Centre in Saudi Arabia was also selected for Achievement & Innovation in Patient Care Delivery, having leveraged Cerner Millennium to automate and reduce the processing time for patient assistance requests from 6 weeks to just 5 to 10 minutes.

The UAE Ministry of Health was selected for Achievement & Innovation in Patient Care Delivery in Nursing Experience after successfully automating the process of producing the 24-Hour Ward Nursing Report using Cerner Millennium.

"Health care services are becoming more efficient and effective as health care institutions are actively taking advantage of state-of-the-art IT technologies. The Cerner Achievement & Innovation Awards clearly demonstrate this ongoing trend by showcasing the tremendous achievements of our clients in leveraging Cerner technology to improve patient care and automating various processes," said Mike Pomerance, vice president and general manager, Cerner Middle East.

"We believe that this initiative will help further improve the quality of health care services by establishing new benchmarks and highlighting the impact of technology in the delivery of basic health care."

The Second Cerner Achievement & Innovation Awards was celebrated during the two-day 2013 Regional User Group (RUG) Conference in Dubai, the annual Cerner event that gathers all of Cerner's clients across the Middle East region.

http://www.ameinfo.com/cerner-achievement-innovation-awards-2013-recognize-344002

Medicine looks to industries for inspiration

■ Connected coverage — selected articles on trends, challenges and controversies in the changing world of medicine.

Posted April 22, 2013

When physicians, hospitals and health systems encounter systemic problems that might lead to inefficient or substandard patient care, they don't always look within to find solutions. In some cases, the ways that nonmedical industries have changed their practices to boost quality, safety or efficiency can provide valuable examples that doctors and other health professionals can adapt to their own situations.

American Medical News has shed light on several instances in which the medical system has borrowed expertise and best practices developed by experts in other occupations that at first glance might appear to be completely unrelated. It might come as a surprise that the lessons learned by professionals overseeing car assembly lines, racing vehicle pit lanes and airplane cockpits can be used to improve medical care. Although they are not perfect analogies, champions of the approaches say the evidence is clear that adapting these solutions thoughtfully can save time, money and lives.

Cardiac treatment improves after taking page from Toyota playbook

The use of “lean management” principles, which focus on boosting productivity through reducing variation and waste, helped make the Toyota Motor Corp. the world's largest automobile manufacturer. New research shows that the principles also are working for hospital interventional cardiac care units, where lean management has entailed standardized admission order sets, immediate alerts for cardiac catheterization teams and regular monitoring of clinical procedures.

Read story

Doctors use Formula One pit crews as safety model

Racing pit crews help their drivers shave valuable seconds off their times through precision and near-perfect synchronization, with the overarching goal of keeping everyone at the track safe in the process. Following the crews' example, U.S. and British hospitals use similar elements of team leadership, situational awareness and data checklists to cut down on the rates of potentially harmful errors when handing off surgery patients to recovery settings.

Read story

Patient safety: What can medicine learn from aviation?

Many believe aviation safety principles such as adherence to checklists, crew resource management and anonymous incident reporting hold great potential for adaptation to the field of medicine — and in some ways they already have been adapted. But some experts caution that patients are not airplanes, and attempting to copy aviation's example without applying those skills to a particular process of medical care will not necessarily yield the results that everyone wants.

Read story

The Real Cost of Education, Auditing and Patient Engagement: $5 PMPM

Kameron Gifford, CPC   www.ermconsltinginc.com

Republican, Democrat or Independent; Provider, Patient or Payor, It doesn’t matter what side of the line you fall on – we can all agree on one thing – Healthcare Reform is as necessary as it is Inevitable. We must align ourselves for the paradigm shift that lies ahead. We can’t continue to repeat the same actions over and over again with the expectation of different results? That, by definition, is insanity.

I recently wrote an article, “Mission Critical, Target Missed: $34.1 Billion in Overpayments to MA Plans in 2012” in which I referenced a recent study that found MA plans were (on average) overpaid $2,600 per beneficiary last year. If we break that down month over month we are looking at approximately $200 per month per enrollee. What did MA plans spend that money on in 2012?

How did their enrollee’s experience of care compare to their neighbors who elected to stick with traditional Medicare? And what about the providers who took care of these patients? How did their experience of providing care to MA members compare to those patients with traditional Medicare?

It might surprise you that the answer to that question would fluctuate greatly depending on who you asked, where they lived, what type of care they needed (or provided) and what plan they were enrolled with (or contracted with) last year.

According to the Kaiser Foundation, Medicare Advantage enrollment grew by 10% in 2012, exceeding 13 million enrollees or 27% of the total Medicare population. Of those 13.1 million, only 26% of all Medicare Advantage enrollees were covered by plans that were rated as above average or excellent, and 575,000 enrollees, about 9% were in plans that were “underperforming” and received less than 3 stars.

This is our solution? A solution that is plagued with complex reimbursement systems and unsustainable costs? One in which the access to care has been severely restricted all in the name of cost reduction? A system in which patients with insurance are unable to access the care they need and as a result do not get cost saving, preventive services. A solution that is only providing average care to the majority of our seniors?

We know that the cost of care is directly proportionate to the value it provides, and to be effective, that value must be meaningful to the patient.

So how much money was invested in 2012 by Medicare Advantage plans to close traditional gaps, improve access to care and educate patients? What incentives were paid to primary care doctors who went over and above the traditional “standard of care” to coordinate, monitor, and deliver care even during those critical periods of transitions? What about on patient outreach? Who is calling the member who hasn’t reached out to their PCP after enrolling? Or, are we only reaching out to those that are over-utilizing services?

Education is the only answer to a sustainable system.

What training is mandated for HCC Coders? Why aren’t physicians being taught the underlying principles of risk adjustment instead of being asked to assign specific ICD-9 codes to their MA members? Where is the transparency that Obamacare was intended to provide?

What if the answer to our healthcare crisis isn’t in the millions of medical records we are auditing and re-auditing? What if the answer isn’t in the “missing diagnosis” codes or the “monetary penalties such as recoupments”?

But, instead in the investment of education for patients, providers and office staff? What if the answer was creating more flexibility in the delivery of care or strengthening communities to bring that sense of responsibility into our neighborhoods? What if we took the money invested in prosecuting and defending waste, fraud and abuse and redirecting it into improving access and developing mobile platforms to meet the needs of patients?

Empirical Risk Management was able to create this personalized, comprehensive, integrated care in our recent pilot program. The cost of the program was less than $5 per member per month, and the value it created extended beyond quality measures and HEDIS - it instilled a desire to make better choices.

If we can innovate for as little as $5,per member per month, I can't help but wonder where the other $195 was spent?

Business Innovations in Global Health Care program

Harvard Business School has launched a new executive education program aimed at improving worldwide healthcare delivery. 

The Business Innovations in Global Health Care program will take place June 26-29 on the HBS campus just outside Boston.

"We created this new program to help entrepreneurs and executives, both in developing and developed countries, think differently," said Regina E. Herzlinger, PhD, professor of business administration and faculty co-chair of the program. "These are exciting times. Before us is a huge opportunity to improve the way that healthcare is delivered and technology is used. We can learn vital lessons from entrepreneurs and private enterprises that are creating innovative ways to deliver basic health services as well as highly targeted care to chronically ill populations."

The program will feature global case studies and engaging discussions allowing participants to learn how entrepreneurs around the world are overcoming barriers to provide more efficient care and medical technology to underserved populations.

"In addition to conventional models, participants will be exposed to enterprises that focus on the base of the pyramid while generating attractive returns," said Michael Chu, MBA, senior lecturer of business administration and faculty co-chair of Business Innovations in Global Health Care. "Global leaders in entrepreneurial health care faced with real-life cases will help each other discover new concepts and practices for their organizations."

© Copyright ASC COMMUNICATIONS 2012.

What Health Insurance Doesn’t Do

By ROSS DOUTHAT

IN one of the most famous studies of health insurance, conducted across the 1970s, thousands of participants were divided into five groups, with each receiving a different amount of insurance coverage. The study, run by the RAND Corporation, tracked the medical care each group sought out, and not surprisingly found that people with more comprehensive coverage tended to make use of it, visiting the doctor and checking into the hospital more often than people with less generous insurance.

But the study also tracked the health outcomes of each group, and there the results were more surprising: With a few modest exceptions, the level of insurance had no significant effect on the participants’ actual wellness.

Needless to say, experts have been arguing about what the RAND results mean ever since. But the basic finding — that more expensive health insurance doesn’t necessarily lead to better health — just received a major boost. The state of Oregon expanded its Medicaid program via lottery a few years ago, and researchers released the latest data on how health outcomes for the new Medicaid users differed from those for the uninsured. The answer: They didn’t differ much. Being on Medicaid helped people avoid huge medical bills, and it reduced depression rates. But the program’s insurance guarantee seemed to have little or no impact on common medical conditions like hypertension and diabetes.

As liberals have been extremely quick to point out, these findings do not necessarily make a case against the new health care law, which includes a big Medicaid expansion as well as subsidies for private insurance. After all, the first purpose of insurance is economic protection, and the Oregon data shows that expanding coverage does indeed protect people from ruinous medical expenses. The links between insurance, medicine and health may be impressively mysterious, but staving off medical bankruptcies among low-income Americans is not a small policy achievement.

This is true. But it’s also true that the health care law was sold, in part, with the promise (made by judicious wonks as well as overreaching politicians) that it would save tens of thousands of American lives each year. There was so much moral fervor on the issue, so much crusading liberal zeal, precisely because this was not supposed to be just a big redistribution program: it was supposed to be a matter of life and death.

But if it turns out that health insurance is useful mostly because it averts financial catastrophe — which seems to be the consensus liberal position since the Oregon data came out — then the new health care law looks vulnerable to two interconnected critiques.

First, if the benefit of health insurance is mostly or exclusively financial, then shouldn’t health insurance policies work more like normal insurance? Fire, flood and car insurance exist to protect people against actual disasters, after all, not to pay for ordinary repairs. If the best evidence suggests that health insurance is most helpful in protecting people’s pocketbooks from similar disasters, and that more comprehensive coverage often just pays for doctor visits that don’t improve people’s actual health, then shouldn’t we be promotingcatastrophic health coverage, rather than expanding Medicaid?

Liberals don’t like catastrophic plans because, by definition, they’re stingier than the coverage many Americans now enjoy. But this is where the second critique comes in: If the marginal dollar of health care coverage doesn’t deliver better health, isn’t this a place where policy makers should be stingy, while looking for more direct ways to improve the prospects of the working poor? Some kind of expanded health security is clearly a good thing — but if we want to promote economic mobility as well, does it really make sense to pour about a trillion dollars into a health care system that everyone agrees is deeply dysfunctional, when some of that money could be returned to Americans’ paychecks instead?

There are a variety of ways this could be accomplished — a bigger child tax credit for struggling families, a payroll tax cut to boost workers, an expanded earned-income tax credit to raise wages at the bottom, health savings accounts that roll over money left unspent. In each case, the goal would be to help people rise by giving them more money and more options for what to do with it, rather than just expanding 1960s-vintage programs that pay medical bills and only medical bills.

It’s to the Republican Party’s great discredit that these policies and goals don’t have enough conservative champions at the moment. But it’s to liberals’ discredit that they remain wedded to the dream of a health care bureaucracy that pays and pays and pays, when in all likelihood we could be spending much less with similar results, and finding better ways to help the poor.

MediFuture 2023 Aims to Disrupt Healthcare Delivery

BY JAN HOLLINGSWORTH | TUESDAY, MAY 07, 2013

The U.S. health care industry may be in crisis, but local business leaders aim to make the Tampa Bay area the epicenter of a global health care revolution.

Where many consumers and providers are agonizing over the tsunami of change that recent health care reforms will bring to the industry, others see an unprecedented opportunity for positive transformation.

"There is not a single community in this country that has planted the flag and said, 'We are going to be the center -- or one of the centers -- of this change,'" says Rick Homans, president and CEO of the Tampa Hillsborough Economic DevelopmentCorporation (EDC).

Homans is the force behind "MediFuture 2023, Healthcare Disrupted," a confab of forward-thinking stakeholders who will gather for the first time on Monday to envision what the future of health care should look like, and to begin shaping the transformation.

Stephen Klasko, CEO of USF Health and Dean of the Morsani College of Medicine, sums up the process with a quote from Buckminster Fuller: "To transform something, make a new model that makes the old one obsolete."

The new model will be shaped to deliver higher levels of care and more access at lower cost. MediFuture participants believe the Tampa Bay region, with its strong foundation of medical providers and researchers, as well as clusters of tech, IT and medical device manufacturing, is uniquely poised to lead the charge into the future of health care.

Organizers have lined up a roster of national movers and regional shakers to explore the institutional, technical and inspirational aspects of revolutionizing the health care landscape.

"The Innovator's Dilemma''

The keynote speaker for the inaugural event is Clayton Christensen, Harvard business school professor, bestselling author and one of world's top management thinkers who can claim Steve Jobs, George Gilder and Andy Grove among the Silicon Valley disciples who embraced his book, "The Innovator's Dilemma."

Christensen's theory of "disruptive innovation," which encourages technologies and business models that may threaten the status quo, can be applied to many industries. But he has been promoting it as a means to raise the quality of health care for the better part of a decade.

Homans says it's an idea whose time has come. "There's just been so much debate and acrimony about health care and Obamacare that it's hard for most people to understand the level of change that is about to occur, and how that could become a huge economic opportunity for Tampa Bay."

The first panel discussion will include Florida Blue CEO Patrick Geraghty and BayCare Health System president and CEO Stephen Mason, who will discuss their approach to surviving and thriving in a disruptive environment.

Klasko, Leonard Polizzotto, vice president of Draper Laboratory and Bill Dalton, CEO of M2Gen, will participate in a second panel that focuses on how research and development play a key role in shaping the technologies of the future.

Dalton, former CEO of Moffitt Cancer Center, believes as many others do, that personalized medicine is the wave of the future, and that "precision medicine" assisted by bio-information -- a homegrown concept that M2Gen has already exported on a large scale -- has already arrived in Tampa Bay.

That kind of entrepreneurial spirit is the key to marshaling the Tampa Bay region's burgeoning resources in medical, technical and educational startups and incubators, says Homans, who would like to parlay Monday's conference into "the Paris Air Show" of health care innovation.

"We need to grab the market space," he says. "We need to define what this new industry is and plant the flag."

Event Details And Link

The inaugural MediFuture 2023 event:
When:    May 13, 2013, 8:30 a.m.
Where:  Tampa Marriott Waterside Hotel & Marina
Cost:       $95 per person (includes keynote presentation and all MediFuture 2023 events, plus continental breakfast, snacks and lunch)

Jan Hollingsworth is a Valrico-based freelance writer working from a restored Victorian parsonage built in the mid-1880s for a Methodist circuit rider. Comments? Contact 83 Degrees.